Click on vaccine below for more information

Authorization and acknowledgement form

This form is signed yearly, usually at your child's physical stating  that you understand the policies at Town Center Pediatrics. 

Forms and Policies

Insurance card                Co pay if required              Identification (for parent/guardian) 

2 months   

4 months            
6 months                
9 months           
12 months 

15 months

18 months

24 months              

3 years

4 years 

5 years 

 6 - 12 years of age
                               


     







 








 The patient forms are PDF files, you may need to download Adobe Acrobat Reader to view them.

​Developmental Questionnaires

If your child has an upcoming well visit, please download and bring the completed questionnaire that corresponds to your child's age to the appointment



Forms and Policies

Policy Information

Medical Record Release Form

Please fill out completely and allow 2-3 weeks for processing.


PLEASE BRING THE FOLLOWING INFORMATION TO EVERY APPOINTMENT